Posted by King Vultan on June 9, 2004, at 17:11:22
In reply to Re: how is wellbutrin an AD, and Ritalin not, posted by Keith Talent on June 9, 2004, at 8:30:22
> It is known that methylphenidate works by inhibiting dopamine reuptake and, at high concentrations, causing dopamine release. Bupropion's mechanism of action, on the other hand, is a bit of a mystery. Some papers say that its potency at inhibiting dopamine reuptake is far too low for THAT to be the mechanism of action. Some papers say that it causes release of noradrenaline. Who knows? From the complaints here at Psycho-Babble, it seems that bupropion increases anxiety without providing a useful energy boost (i.e. stimulation) nor much of an antidepressant effect.
>
> So, I guess my answer is that bupropion is really NOT an antidepressant (very little anyway), but that methylphenidate is very commonly used to augment antidepressants, and can be used alone as an antidepressant (such as in medically ill patients).
>I tend to subscribe to the view that the metabolites of bupropion are what really need to be focused on, as they build up to enormous concentrations relative to the parent drug. In any case, it appears that bupropion's net effect is as a combined norepinephrine/dopamine reuptake inhibitor and might almost be looked at as a weak, weak version of the stimulants.
It also appears that it unfortunately winds up not being a terribly effective antidepressant because of a number of factors, including a relatively narrow therapeutic window and its tendency to cause agitation in patients who oftentimes have concomitant anxiety disorders. My own experience was that the agitation and insomnia were quite transitory and went away within a few weeks, but I really needed 300 mg/day to get an antidepressant effect, and this dosage induced extreme irritability after a few months on the drug. I found 150 mg/day to be completely worthless and 225 mg/day to not do much at all.
So in essence, I agree with you that it winds up not being much of an antidepressant, but it does have some applicability in certain situations. A co-worker with ADD is taking 2 x 200 mg/day of Wellbutrin SR and 2 x 15 mg/day of methylphenidate and finds that this combination works extremely well. There are apparently some people who can tolerate a high enough dose of Wellbutrin to get an antidepressant effect, but judging from this board, a lot of people seem to have problems with it.
Todd
poster:King Vultan
thread:354773
URL: http://www.dr-bob.org/babble/20040608/msgs/355192.html